Coping with Injury
Psychological Impact of Athletic Injury
Athletic injury is a significant stressor for athletes.3 With injury, athletes often see major changes to their daily routines, such as not going to practice anymore, or spending more time in the training room, and can experience a complex array of emotions such as fear of not being able to return to their previous playing level, boredom, or feeling isolated from teammates. When an athlete experiences an injury, they need to process the medical information regarding the injury, and then emotionally cope with the injury. Every athlete responds differently to injuries. However, normal emotional responses and coping are involved post-injury, and all athletes differ in their emotional response to injuries. Normal emotional responses may include sadness, isolation, irritation, lack of motivation, anger, frustration, changes in appetite, sleep disturbances, and disengagement.3 With healthy coping strategies and gradual injury recovery, these responses tend to resolve over time.Problematic reactions, however, are emotional responses that do not resolve, worsen over time, or seem excessive in severity.3 These may include sustained alterations of appetite, chronic sleep disturbances, irritability, disordered eating, sadness leading to depression, lack of motivation leading to apathy, disengagement leading to alienation, pain infliction behaviors, excessive anger or rage, frequent crying or emotional outbursts, and substance abuse, gambling and legal problems. Substance use is a common problematic response to injury; often, substances are used to self-medicate in an attempt to improve mood or depression. It is also not uncommon for multiple problematic responses to occur at the same time, such as alcohol abuse and depression, depression and eating disorders, and alcohol and fighting. In a study with Division I football players, 33% of injured players reported high levels of depressive symptoms.3 Significant problematic responses can be triggered following an injury, so finding a healthy way to cope is important.
Coping with Season-Ending Injury | Athletes Connected
Resources to Seek Help
Resilience & Coping
Coping is the process we go through to adjust to the stressful demands of everyday life. 1 It involves emotional processing, information processing, and behavioral responses. Resilience is the ability for a person to effectively cope with, adjust to, or recover from stress or adversity. Resilience is a capacity that can be built over time within the context of interactions between the person and their environment.4 Resilience is important for athlete wellness and sports performance because athletes need to find a way to optimize and utilize various protective factors in their lives in order to withstand the many distinct stressors they combat. Such protective factors may be personality traits, social support, access to healthcare resources, healthy sleep habits, and more. Researchers have suggested that aspiring performers should actively seek out moderately challenging situations to use previously untapped resources, preparing for future stressors, and making stressors (such as athletic injury) more manageable when they happen.4From interviews with Olympic champions, researchers found the world's best athletes protect themselves from stressors by changing their meta-cognitions (thinking about thinking) and challenge appraisal (personal interpretation of task demand). These changes promoted facilitative responses to stress such as taking personal responsibility for one's own feelings, actions, and thoughts. Such positive responses to adversity have guided world-class athletes to the fulfillment of optimal sports performance. There is a resilience-stress-performance relationship found among athletes. Positive personality, motivation, confidence, focus, and perceived social support were several psychological phenomena found among Olympic champions that grounded this resilience-stress-performance interaction. These core psychological factors of resilience help protect athletes from potential negative effects of stressors. Psychological resilience is an important factor for promoting mental well-being and sports performance among athletes.4 Building resilience improves the ability to cope with adversity such as injury.
Learn from the Olympians:
Researchers have found these 5 psychological factors among Olympic champions, and suggest that these are core facets of resilience that can protect athletes from negative effects of stressors.4 Keep in mind that resilience is something you can work on. People are not born with resilience - it is a skill that develops with practice over time.1. Positive Personality
Researchers found that Olympic gold-medalists demonstrated multiple positive personality characteristics that helped them overcome the many stressors involved with being an elite athlete. These included adaptive perfectionism, optimism, competitiveness, hope, and proactivity.4 Adaptive perfectionism is a type of perfectionism where the person does not spend time worrying about mistakes or fear of failure, but still has high personal standards and continually strives for excellence. Optimism is an approach to explaining negative and positive events and is also a trait-like expectancy for successful outcomes. Optimism has been associated with lower levels of competition anxiety, improved emotional adjustment during competitions, and task-oriented coping strategies after performance slumps. Competitiveness is the desire to win. This trait helps athletes adapt to setbacks such as injuries because they view the setbacks as part of the journey to the excellence they so-desire. Hope is a cognitive pattern where the person is able to make goals, engage in goal-directed action, and find pathways to meet these goals. Hopeful people are able to come up with new ways to meet their goals when their attempts are foiled, rather than giving up. Proactivity is when the person takes initiative, finds opportunities and acts on them, and demonstrates perseverance until they make meaningful changes. It is the extent to which a person takes action to change their own environments. These traits are important parts of psychological resilience, because they change an athlete's reaction to adversity, making the reaction more positive and goal-directed.4
2. Motivation
Motivation is essential for withstanding pressure in elite sports in addition to stress. Motivation is the "what" and the "why" of behavior. Common motives among Olympic champions include social recognition, passion for the sport, "being the best you can be", achieving incremental approach goals, exhibiting competence, and proving their worth to others. Optimal levels of motivation are often reported as a psychological attribute that is required for combating stress and pressure in sports.
3. Confidence
Confidence has a positive effect on the ability of athletes to cope with stress and pressure in elite sport. Confidence is the degree of certainty that a person possesses regarding their own ability to compete successfully in sports. Confidence can come from a variety of places. However, among the Olympic gold-medalists, the primary sources of confidence were self-awareness, visualization, coaching, teammates, experience, and multi-faceted preparation.4
4. Focus
Focus is the ability to concentrate or give deliberate mental effort to what is the most important in the specific situation. Research has shown that focus is an essential part of resilience found among Olympic champions. The ability to focus helps athletes process information in their environments when under pressure, helping them compete more effectively.4
5. Perceived Social Support
Perceptions of strong social support have helped to protect Olympic champions from the pressures of elite sport. Perceived social support is the person's potential access to social support, and is the person's judgment that friends, team-mates, and coaches would give assistance to them if needed. In other words, perceived social support is "having people in your corner."
Resilience Training:
- Psychology Today: 9 Ways to Strengthen Your Resilience
- Berkeley Greater Good Magazine: Five Science-Backed Strategies to Build Resilience
- American Psychological Association: Building Your Resilience
- TED Ideas: Tips for becoming more resilient
- TED Talk: 3 Secrets of Resilient People
Coping
Coping mechanisms are strategies people use to face adversity, deal with the aftermath of trauma, and/or manage painful feelings. Coping helps people get through tough times, such as dealing with the difficulties involved with the athletic injury. It is important to find healthy ways to cope with adversity, to help you optimize your recovery. Here are the two major types of coping.
- Problem-focused: These are coping strategies that deal with the problem directly, in order to reduce stress. Doing injury rehab with the trainer is an example of a problem-focused coping strategy post-injury.
- Emotion-focused: These are coping strategies that help the person deal with the emotional distress that comes with the problem. For example, talking through the athletic injury with a friend would be an emotion-focused strategy.2
Common Coping Strategy Clusters1
- Cognitive restructuring: efforts to find and embrace the positive aspects of the situation, such as "I crashed my car, but at least I have my shoes so I can walk."
- Emotional expression: directing anger or humor at the situation
- Wish-fulfilling fantasy: imagining an improved situation, such as becoming a millionaire or suddenly have the athletic capabilities of Peyton Manning
- Self-blame: refocusing attention to blame oneself for a stressor, as a form of avoidance
- Information seeking: looking for advice and information about the situation and coping strategies other people use in similar situations.
- Threat minimization: denying or avoiding stressful thoughts and putting them out of one's mind.
Healthy coping mechanisms to try:2
There are a variety of ways to cope with athletic injury, and everyone is different. Before you do an activity to cope, ask yourself -- is this activity helping or hurting me? If you have an injury and find yourself looking through your teammates' Instagram posts about their performance achievements and it makes you feel down and hopeless, then take a break from Instagram and find an activity that helps you. Here are some suggestions.- Support: Talking about the stressful event with a friend, family member, teammate, counselor, or other trusted person can be an effective way to manage stress. Finding external support instead of self-isolating and internalizing the effects of stress can reduce the negative effects of a difficult situation.
- Stay Involved: We as humans are social creatures and thrive with involvement in our communities. Keep coming to practice during injury recovery, even if it's to help manage the team. Get involved with Student-Athlete Advisory Committee (SAAC), spend time with your teammates, and/or check-in with your coaches.
- Relaxation: Any number of relaxing activities can help people cope with stress. Relaxing activities may include practicing mindfulness meditation, progressive muscle relaxation, or other calming techniques such as taking a bath, breathing exercises, or listening to soft music.5 More about stress management HERE
- Problem-solving: This involves identifying a problem that is causing your stress and then coming up with some potential solutions for effectively managing it, and putting those into action.
- Example: You identify your stressor as the threat of losing sports eligibility due to current failing grades in several classes. One solution would be to get a tutor in each class, make a study schedule, and write goals for these solutions.
- Humor: Making light of a stressful situation can help people keep perspective and prevent the situation from becoming completely overwhelming. If you are having difficulty making light of things, you could listen to your favorite stand-up comedian to get a few laughs in.
- Physical activity: Exercise can serve as a natural and healthy form of stress relief. This is something that can be missing if you are experiencing an athletic injury. Finding a form of physical activity you are able to do will help you psychologically cope with the injury. If your ACL is injured, you could use an arm-bike, or do some arm swimming in the pool. Ask your trainer what physical activity you can do while you recover. Many different types of physical activity can help people cope with stress and the aftermath of traumatic events, such as athletic injury.2
- Focus on the things you can control: There are always things in life that are out of our control. Focusing on the things you can control is a helpful way to manage stressors, especially when the stressor itself is out of your control. For example, if you are recovering from an injury, it is out of your control that you have an injury. However, doing your rehab, practicing good sleep hygiene, and having a positive attitude are all within your control, so focus on those things.
- Try completing the: Circles of Control Worksheet (PDF) to gain perspective
Maladaptive coping mechanisms: to avoid
- Escape: To cope with anxiety or stress, some people may withdraw from friends, teammates, and/or family and become socially isolated. Absorbing oneself in solitary activities such as watching TV, reading, or scrolling on social media are examples of "escape" activities.
- Unhealthy self-soothing: Some self-soothing behaviors can be healthy in moderation but can also trigger unhealthy addictions if gone unchecked or have other health consequences. Examples of unhealthy self-soothing may include overeating, under-eating, overexercising, binge drinking, or excessive use of the internet or video games. There is nothing wrong with eating a brownie or drinking a glass of wine when you need it, but these self-soothing methods should be used with caution because they can trigger disordered eating, weight gain, or alcohol use disorder.
- Numbing: Numbing behaviors are activities that help the person drown out or override their distress. They are often aware of what they are doing and may seek help. Stress-numbing activities may include eating junk food, excessive alcohol use, or using drugs.
- Compulsions and risk-taking: Stress can trigger people to seek an adrenaline rush through compulsive or risk-taking behaviors. These may include gambling, backcountry skiing alone with no avalanche kit, unsafe sex, experimenting with drugs, bar fights, theft, or reckless driving such as driving under the influence.
- Self-harm: People may engage in self-harming behaviors to cope with extreme stress or trauma. This may include biting, cutting, pinching, or extreme exercise.2
Am I Coping Well?
More About Coping
- Coping with COVID-19
- Coping with Racial Trauma
- Coping With Stress and Supporting Mental Health During the COVID-19 (PDF)
- Stress Management for Athletes
- MUSC Health: How Athletes Cope with Injury
- Overcoming Helplessness
- Coping Strategies for Trauma
References
- Haertl, K. & Christiansen, C. (2011). Coping Skills. In C., Brown, V., Stoffel, & J., Muñoz (Eds.), Occupational therapy in mental health: A vision for participation (pp. 313 – 326). Philadelphia, PA: F. A. Davis Company
- Good Therapy (2007-2021). Coping mechanisms. Retrieved from: https://www.goodtherapy.org/blog/psychpedia/coping-mechanisms
- Putukian, M. (2016). The psychological response to injury in student athletes: a narrative review with a focus on mental health. British Journal of Sports Medicine, 50(3), 145–148. doi: 10.1136/bjsports-2015-09558
- Sarkar, M., & Fletcher, D. (2014). Psychological resilience in sport performers: a review of stressors and protective factors. Journal of Sports Sciences, 32(15), 1419–1434. doi: 10.1080/02640414.2014.901551
Developed 2021 by Quinn DeStefano, OTD Student
Reviewed 2021 by Aaron Grusonik, MA, Psy.D
